Nevada public health officials tell the story of a Washoe County resident who appeared at a Reno hospital in August 2016 with sepsis. Doctors found out that she was infected with a type of carbapenem-resistant enterobacteriaceae, or CRE, superbug called Klebsiella pneumoniae and quickly put her in isolation. Tests showed that the bacterium, which spread throughout her body, was resistant to 26 different antibiotics — or every antibiotic available in the US.
In early September, the woman, who was in her 70s, developed septic shock and died.
What makes this case particularly alarming is that the infection probably didn’t originate in the US. The woman had spent significant amounts of time in India, and while there, was hospitalized on several occasions over two years for a femur fracture and later, bone infections.
India has a major superbug issue, particularly in its hospitals. The authors of the report suggest the patient may have picked up her infection while in hospital there.
No one else seems to have caught this superbug from the woman. But the authors say a lesson here is that health care workers in the US need to get a history of all the “health care exposures” from their patients with CRE and “consider screening for CRE when patients report recent exposure outside the United States or in regions of the United States known to have a higher incidence of CRE.”
This is a frightening story of a deadly bacterium doctors couldn’t control — and the real limits of our antibiotic arsenal. But it’s also a reminder of how tricky the superbug problem will be to solve without a lot of international collaboration.
Countries can’t solve the superbug problem alone
In recent years, antibiotic misuse has accelerated the natural process of bacterial resistance, rendering some antibiotics useless and causing experts to warn that we are at the "dawn of a post-antibiotic era" that amounts to a health threat on par with terrorism.
The US has its own serious problem with antibiotic-resistant infections: They’re associated with 23,000 deaths and 2 million illnesses every year. We’ve already seen a number of different ones — gonorrhea, CREs, strains of tuberculosis — no longer respond to any of the drugs we have.
Though these situations are still rare, experts have warned that they are likely to become more common in the near future. A recent report commissioned by the UK government contains an alarming prediction: By 2050, antimicrobial-resistant infections will kill 10 million people across the world — more than the current toll from cancer.
Without antibiotics that work, common medical procedures like hip operations, C-sections, or chemotherapy will become more dangerous, and some medical interventions — organ transplants, chemotherapy — would be impossible to survive. And it’s not just medicine: The modern agricultural practices that give us our abundant food supply also depend on these drugs.
But even if some countries or major players take action against superbugs, they won’t be able to fix the problem alone. To truly address this issue, we need a global plan. (Remember: Microbes travel as easily as people can hop on planes.) We also need sectors — from health, agriculture, and security — to work together.
Recently, there’s been more focus on antimicrobial resistance. In September, the UN convened a rare high-level meeting at the General Assembly to address superbugs. Health experts called it a major turning point and a potential boost for globally coordinated action. (You can read all about it here.)
But that meeting was more about galvanizing political attention and getting countries to commit to addressing the problem than creating global regulations or laws. And so far, we have done terrifyingly little to curb the resistance crisis at the global level, and the problem has been deemed "a classic 'tragedy of the commons'" on par with climate change.
In low- and middle-income countries, like India, the major driver of infections — and the need for antibiotics — is still poor sanitation. Many people live in areas that have been contaminated by human and animal waste, which is why ensuring clean water and sanitation for all are key to preventing the need for antibiotics. On the flip side, uncontrolled antibiotic use or the lack of access to the drugs when people need them are also drivers of the superbug problem.
In cases where poorer countries can’t address these problems themselves, global health groups and wealthier countries (like the US) will need to step in to help out. Until every country gets a grip on its superbug problem, we will keep seeing tragedies like the one in Reno turn up close to home.